Methadone & Other Opiate Maintenance

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Seattle Aims to Open the First Safe Injection Sites in the US [FEATURE]

Seattle and surrounding King County are on a path to establish the country's first supervised drug consumption sites as part of a broader campaign to address heroin and prescription opioid misuse. A 99-page report released last week by the Heroin and Prescription Opiate Addiction Task Force calls for setting up at least two of the sites, one in the city and one in the suburbs, as part of a pilot project.

The facilities, modeled on the Canadian government-funded InSite supervised injection site in Vancouver, just 140 miles to the north, would be places where users could legally inject their drugs while under medical supervision and be put in contact with treatment and other social services. There have been no fatal overdoses in the 13-year history of InSite.

Although such facilities, which also operate in various European countries and Australia, have been proven to reduce overdose deaths and drug use-related disease, improve local quality of life, and improve the lives of drug users, they remain controversial, with foes accusing them of "enabling" drug use. Thus, the report refers to them not as "safe injection sites," or even "supervised consumption sites," but as the anodyne "Community Health Engagement Locations" (CHELs).

"If it's a strategy that saves lives then regardless of the political discomfort, I think it is something we have to move forward," said County Executive Dow Constantine, discussing the plan at a news conference last week.

The safe sites will address the region's high levels of opioid and heroin use, or what the task force called "the region's growing and increasingly lethal heroin and opioid epidemic." As the task force noted, the number of fatal overdoses in the county has tripled in recent years, with the rate of death rising from roughly one a week (49) in 2009 to one very other day (156) in 2014. The current wave of opioid use appears centered on young people, with the number of people under 30 seeking treatment doubling between 2006 and 2014, and now, more young people are entering detox for heroin than for alcohol.

Outside Vancouver's InSite (vch.ca)
Overdose deaths actually dropped last year to 132, thanks to Good Samaritan laws that shield people who aid overdose victims from prosecution and to the wider use of the opioid overdose reversal drug naloxone. But that's still 132 King County residents who needn't have died. Task force members said the CHELs would help reduce that number even further.

"The heroin epidemic has had a profound effect not just on our region, but across our country as a whole," said Seattle Mayor Ed Murray. "It is critical that we not only move forward with meaningful solutions that support prevention and treatment, but that we remove the stigma surrounding addiction that often creates barriers to those seeking help.

Not only are key local elected officials on board, so is King County Sheriff John Urquhart. He said the safe site plan was workable.

"As long as there was strong, very strong, emphasis on education, services, and recovery, I would say that yes, the benefits outweigh the drawbacks," he said. "We will never make any headway in the war on drugs until we turn the war into a health issue."

The region may willing to embrace this ground-breaking harm reduction measure, but it is going to require some sort of federal dispensation to get around the Controlled Substances Act and the DEA. How that is going to happen remains to be seen, but Seattle is ready.

The task force wasn't just about CHELs. In fact, the safe sites are just a small, if key, component of a broad-based, far-ranging strategy to attack the problem. The task force report's recommendations come in three categories:

Inside Vancouver's InSite (vch.ca)
Primary Prevention

  • Increase public awareness of effects of opioid use, including overdose and opioid-use disorder.
  • Promote safe storage and disposal of medications.
  • Work with schools and health-care providers to improve the screening practices and better identify opioid use.

Treatment Expansion and Enhancement

  • Make buprenorphine more accessible for people who have opiate-use disorders.
  • Develop treatment on demand for all types of substance-use disorders.Increase treatment capacity so that it’s accessible when and where someone is ready to receive help.

Health and Harm Reduction

  • Continue to distribute more naloxone kits and making training available to homeless service providers, emergency responders and law enforcement officers.
  • Create a three-year pilot project that will include at least two locations where adults with substance-use disorders will have access to on-site services while safely consuming opioids or other substances under the supervision of trained healthcare providers.

Will Seattle and King County be able to actual implement the CHELs? Will the federal government act as obstacle or facilitator? That remains to be seen, but harm reductionists, policymakers, and drug users in cities such as Portland, San Francisco, and New York will be watching closely. There have been murmurs about getting such sites up and running there, too.

Chronicle AM: Seattle Call for Injection Sites, Duterte Wants More Lethal Drug War, More... (9/20/16)

A Seattle/King County heroin task force has recommended two safe injection sites be established, a California bill to let landlords ban medical marijuana smoking dies, Nevada legalization foes get organized, and more.

from the anti-legalization Protecting Nevada's Children website
Marijuana Policy

Nevada Legalization Foes Get Organized. Opponents of the Question 2 legalization initiative have organized as Protecting Nevada's Children, complete with a slick website that warns that "legalizing marijuana… like giving candy to a baby." Officials with the no campaign are also worrying about "a well-prepared workforce" if Las Vegas becomes "the Amsterdam of the West." The group refuses to divulge its funding, saying it would be revealed in mid-October, when campaign finance reports are due.

Medical Marijuana

California Bill to Let Landlords Ban Medical Marijuana Smoking Dies. Assemblyman Jim Wood (D-North Coast) has dropped his bill that would let landlords ban smoking medical marijuana after he conceded he was unable to figure out how to meet the needs of medical marijuana patients.

Harm Reduction

Seattle Heroin and Opioid Task Force Issues Report, Calls for Two Safe Injection Sites. The King County Heroin and Opiate Addiction Task Force has issued a final report calling on increased prevention and access to treatment for addicted users. Among other recommendations, the report calls for authorities to "Create a three-year pilot project that will include at least two locations where adults with substance-use disorders will have access to on-site services while safely consuming opioids or other substances under the supervision of trained healthcare providers." Look for a detailed article on the task force recommendations tomorrow.

Sentencing Reform

North Dakota Legislature Squabbles Over Drug Sentences. Legislators are working off-session on a pair of criminal justice reform bills aimed at curbing a growing prison population, but some are reluctant to embrace reductions in drug sentences that experts said were necessary to actually achieve prison population cuts. There was support for reducing some sentences for drug possessors, but not for drug sellers. A proposal from the Department of Corrections and Rehabilitation to eliminate mandatory minimums for people dealing drugs was rejected. But a proposal from the Council of State Governments to make probation the presumptive sentence for first-time, low-level felonies was accepted. The bills will be introduced at the beginning of the next session.

International

Philippines President Wants Six More Months of Drug War Because He "Cannot Kill Them All" Fast Enough. Even as the death toll from President Rodrigo Duterte's slow motion massacre of drug suspects tops 3,000, the hardline leader is saying he wants to extend his crusade another six months. "I did not realize how severe and how serious the drug menace was in this republic until I became president," Duterte said. "Even if I wanted to I cannot kill them all because the last report would be this thick," he said, referring to a new police list of people including top officials suspected of being involved in the drugs trade.

Chronicle AM: CA&MA Polls, Kratom Proponents Mobilize, Canada OKs Prescription Heroin; More... (9/14/16)

The polling is looking good in Massachusetts and better in California, there will be no initiative for Michigan this year, kratom proponents fight a proposed DEA ban, Canada gives the go-ahead for expanded heroin prescribing, and more.

The Canadian government has cleared the way for limited heroin prescribing for hard-core users. (Creative Commons)
Marijuana Policy

Marijuana Could Be a $50 Billion a Year Industry Within a Decade. A new report from financial analysts Cowen & Company says the legal weed industry could grow to a $50 billion a year business by 2026. The report notes that legalizing pot in California alone could triple the size of the industry, currently around $6 billion a year.

California: LA Times Poll Has Prop 64 at 58%. The Prop 64 legalization initiative is supported by 58% of voters, according to a new USC Dornsife/Los Angeles Times poll. Only 34% said they would vote against the measure, with 8% undecided. "It's very clear that Californians' attitudes have changed dramatically on this issue over the last several years," said Dan Schnur, director of the poll and of the Jesse M. Unruh Institute of Politics at USC. "The opposition is going to have to identify a fairly sizable source of campaign funding if this initiative is to be close," he added.

California: Eyewitness News/Southern California Newsgroup Poll Has Prop 64 at 52%. The Prop 64 legalization initiative has 52% in a new poll from Eyewitness News/Southern California Newsgroup. Some 40% said they would vote no, with 8% undecided.

Massachusetts Poll Has Legalization Initiative Up By Five Points. A new poll from WBUR TV has support for the Question 4 legalization initiative at 50%, with 45% opposed. "There's some big demographic splits, particularly along age lines," pollster Steve Koczela said. "Younger people are very much in favor of legalization, and it declines steadily as you move up the age brackets to where you get to voters who are 60-plus, and they're opposed to it by a 17-point margin."

Federal Judge Puts Final Nail in Coffin of Michigan Legalization Initiative. A federal court judge rejected a last chance effort by MI Legalize to get its legalization initiative on the November ballot. Judge Linda Parker Tuesday denied a motion from the group to stop the printing of election ballots, saying there was not enough time to stop the election process. MI Legalize gathered enough signatures to qualify for the ballot, but some of them came outside a 180-day mandated by state law. MI Legalize challenged rulings by state officials that knocked those signatures off the tally, but lost in the state courts -- and now, in federal court.

Kratom

Kratom Supporters Fight Proposed DEA Ban. Proponents of the Southeast Asian plant with mild opium-like qualities have mobilized to block the DEA proposed emergency move to place the substance on Schedule I of the Controlled Substances Act. Hundreds marched in front of the White House Tuesday and more than 120,000 have signed a Change.org petition opposing the ban, meaning the White House will have to publicly address the issue.

International

Canada Has Approved Prescription Heroin. The Canadian government last week quietly approved new regulations that will allow doctors to prescribe diacetylmorphine (heroin) to long-term users who have not responded to more conventional approaches to weaning them from the drug. The Crosstown clinic in Vancouver is currently the only place in the country with a heroin maintenance program, but that should now not be the case for long.

British MPs Call for Medical Marijuana. The All Party Parliamentary Group on Drug Policy Reform has called for medical marijuana to be legalized in the United Kingdom. The call comes on the heels of a report by neurologist Dr. Mike Barnes urging that marijuana be moved from Schedule I to Schedule IV on the British drugs classification scheme. "Many hundreds of thousands of people in the UK are already taking cannabis for primarily medical reasons," said MP Caroline Lucas, who co-chairs the group. "It is totally unacceptable that they should face the added stress of having to break the law to access their medicine."

Chronicle AM: MJ Taxes Could Generate Billions, Canada to Allow Prescription Heroin, More... (5/16/16)

A Tax Foundation study finds that legal pot could generate $28 billion a year in tax revenues, CBD cannabis oil isn't enough for Oklahoma medical marijuana activists, Canada will allow prescription heroin, and more.

DC activists and veterans head for the White House next week to press for end to marijuana prohibition. (Adam Eidinger/Twitter)
Marijuana Policy

Study Finds Legal Marijuana Could Generate Billions a Year in Tax Revenues. A new report from the Tax Foundation estimates that a nationwide "mature marijuana industry" could generate up to $28 billion a year in federal, state, and local tax revenues. That would include $7 billion for the feds, $5.5 billion in business taxes, and $1.5 billion from income and payroll taxes. The report also estimated that a 10% federal surtax could generate $5.3 billion a year.

Veterans, DC Activists to Rally at White House on May 20. Organizers with the Weed For Warriors Project and the DC Cannabis Campaign are planning to rally in front of the White House to call on the Obama administration to end federal marijuana prohibition. The date, May 20, marks the 124th anniversary of the birth of arch-prohibitionist and proto-drug warrior Harry Anslinger, head of the Federal Bureau of Narcotics for three decades in the mid-20th Century.

Medical Marijuana

Montana Medical Marijuana Supporters Appeal to US Supreme Court. The Montana Cannabis Industry Association last Thursday filed a petition with the US Supreme Court seeking to reverse a state Supreme Court decision that guts the state's once-thriving medical marijuana industry. Petitioners argue that the state Supreme Court mistakenly held that marijuana is universally illegal under federal law and point to the Obama administration's decisions to allow states to implement their own marijuana laws.

Oklahoma Governor Signs CBD Cannabis Oil Bill. Gov. Mary Fallin (R) has signed into law a CBD cannabis oil expansion bill. Last year, the state approved the use of the oil, but only for people under 18. This bill removes that age restriction.

Oklahoma Medical Marijuana Advocates Begin Initiative Signature Gathering Campaign. CBD cannabis oil isn't enough for Oklahomans for Health, which began gathering signatures over the weekend for a full-blown medical marijuana initiative. The group has 90 days to gather 66,000 valid voter signatures to get the measure on the November ballot.

Heroin and Prescription Opioids

Congress Passes Comprehensive Addiction and Recovery Act. Both houses of Congress have approved the measure, Senate Bill 524 and HR 953, which now goes to President Obama. The bill would expand the availability of naloxone, increase prescription drug monitoring programs, increase jail- and prison-based drug treatment, and bar the Education Department from asking about drug convictions on federal student loan application forms, among other provisions. The bill does not include extra funding to pay for its measures.

Obama Administration Calls on Congress to Fund $1.1 Billion for Opioid Effort. Last Thursday, as Congress was passing the Comprehensive Addiction and Recovery Act, the Obama administration noted that Congress didn't allocate money to pay for it and called on Congress to come up with $1.1 billion in additional spending to do so.

International

Canada to Allow Prescription Heroin. Health Canada announced Friday that it is proposing new regulations to allow access to prescription heroin under its Special Access Program (SAP). That program allows for emergency access to drugs for serious or life-threatening conditions when conventional treatments have failed or are unsuitable. "A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic, relapsing opioid dependence. Diacetylmorphine is permitted in a number of other jurisdictions, such as Germany, the Netherlands, Denmark, and Switzerland, to support a small percentage of patients who have not responded to other treatment options, such as methadone and buprenorphine," the statement said.

Macedonia Will Have Medical Marijuana by Month's End. Health Minister Nikola Todorov said Saturday that medical marijuana products will be in pharmacies across the country by the end of the month. The country had earlier amended its Law on the Control of Drugs and Psychotropic Substances to allow the move.

In Cutting Edge Move, Canada to Allow Prescription Heroin

This article was produced in collaboration with AlterNet and first appeared here.

Health Canada announced Friday that it is proposing new regulations to allow access to prescription heroin under its Special Access Program (SAP). That program allows for emergency access to drugs for serious or life-threatening conditions when conventional treatments have failed or are unsuitable.

Health Canada clears the way for prescription heroin. (Wikmedia/Creative Commons)
"A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic, relapsing opioid dependence. Diacetylmorphine is permitted in a number of other jurisdictions, such as Germany, the Netherlands, Denmark, and Switzerland, to support a small percentage of patients who have not responded to other treatment options, such as methadone and buprenorphine," the statement said.

The move is yet another reversal of hardline Conservative drug policies by the Liberal government headed by Prime Minister Justin Trudeau, which was elected last fall. The Trudeau government has pivoted sharply away from Conservative positions in favor of mandatory minimum drug sentences and against marijuana legalization, and now is moving to undo Conservative efforts to block the limited use of prescription heroin.

Canadian scientists had laid the groundwork for prescription with the North American Opiate Medication Initiative (NAOMI), which first tested "heroin-assisted maintenance" in Vancouver a dozen years ago, and which was followed by the Study to Assess Long-Term Opioid Maintenance Effectiveness (SALOME) between 2005 and 2008. SALOME examined whether giving hard-core heroin users heroin was more effective than giving them methadone.

SALOME showed that the users in the study were more likely to stay in treatment, reduce other illegal drug use, engage in fewer other illegal activities and have better physical and mental health outcomes if given heroin than if given methadone. But when that study ended in 2008, researchers were faced with the ethical dilemma of cutting off the patients whose lives were being improved by prescription heroin.

The doctors began applying for, and receiving, permission under the Special Access Program, and Health Canada approved those applications in 2013. But that infuriated the Conservatives, and then-Health Minister Rona Ambrose introduced new regulations to bar doctors from prescribing "dangerous drugs" such as heroin, cocaine, and LSD.

Former SALOME participants launched a constitutional challenge to the ban and in 2014 won a temporary injunction giving them the right to continue to receive prescription heroin while the case was being decided. Now, with Health Canada's move, the federal government will no longer attempt to block prescription heroin.

That was good news for the Pivot Legal Society, which argued the case for continuing the prescriptions, and for Providence Health Care, in whose Crosstown Clinic in Vancouver's Downtown Lower East Side the heroin was administered.

"Allowing access to diacetylmorphine, or medical heroin, to patients who need it, ensures that life-saving treatments get delivered to vulnerable people suffering from chronic opioid use," the two groups said in a joint statement.

Canada is leading the way on cutting edge responses to heroin addiction in North America. In addition to the groundbreaking NAOMI and SALOME studies, which cannot be replicated in the US under current law and regulations, Canada has also had safe injection sites operating in Vancouver for more than a decade. We still don't have any of those in the US.

Ottawa
Canada

Chronicle AM: New Obama Opioid Initiative, DOJ Backtracks on Forfeiture Reform, More... (3/29/16)

The drug czar uses a recycled and updated version of the gateway theory to oppose marijuana legalization, the Justice Department restarts its Equitable Sharing asset forfeiture program, the president announces a new package of initiatives to fight heroin and opioid death and addiction, and more.

Obama has plans for fighting heroin and prescription opioid death and addiction. (wikimedia.org)
Marijuana Policy

Drug Czar Leans On Gateway Theory Variant to Explain Opposition to Legalization. In a hearing before the House Committee on Oversight and Government Reform last week, Office of National Drug Control Policy head Michael Botticelli reaffirmed the Obama administration's opposition to marijuana legalization, using a familiar, if discredited, argument to do so: "I think the evidence is pretty clear that early use of alcohol, tobacco and marijuana -- often used together -- significantly increases the probability that someone will develop a more significant addictive disorder later in their life," he said. "Early substance use actually effects brain development and predisposes people for more significant vulnerabilities later in their life." That sounds a whole lot like an updated version of the roundly criticized gateway theory.

Hawaii Resolution Seeks Study on Marijuana and Driving. Rep. Cindy Evans (D-North Kona) and 15 other lawmakers have introduced a resolution asking the state health department to study the effect of marijuana on driving. State law bans people from driving under the influence of impairing drugs, but there is no threshold set for marijuana because there is no widespread consensus on what an acceptable level might be.

Heroin and Prescription Opioids

Obama Announces New Moves to Fight Heroin and Opioid Abuse. In a speech in Atlanta today, President Obama unveiled a package of new initiatives to help stem the tide of death and addiction from prescription and non-prescription opioids. These initiatives are above and beyond the $1.1 billion in new spending he proposed last month. The package includes expanded access to medication-assisted treatment (methadone, buprenorphine) for addicted users, doubling the cap on the number of patients to whom a doctor may prescribe buprenorphine, increasing the number of doctors who can prescribe it, funding an increase in access to the overdose reversal drug naloxone (Narcan), ensuring that substance abuse and mental health benefits are offered for Medicaid and the Children's Health Insurance Program, and $7 million for the Justice Department to conduct law enforcement operations aimed at heroin distribution.

Asset Forfeiture

Justice Department Resumes Equitable Sharing Program -- More Money for Cops. The Justice Department has announced it is resuming its program that allows state and local law enforcement agencies to do an end run around state asset forfeiture laws by handing investigations over to the feds. State laws may mandate that seized funds go in the general fund or other specified funds, but under the federal program, 80% of the seized funds go to the seizing law enforcement agency, not the state's general or other specified funds. Law enforcement lobbying groups had been loudly protesting the program's shutdown last fall, claiming they needed the windfalls to do their jobs. Now, the program is back on line.

Harm Reduction

Overdose Reversal Drug Naloxone Has Saved 2,500 Lives in North Carolina. In less than three years, some 2,500 North Carolinians have had their heroin or prescription opioid overdoses reversed by people using naloxone (Narcan), the North Carolina Harm Reduction Center reported today. As of today, the number stands at 2,503. "Through distributing naloxone with NCHRC, I have been able to save the lives of many of my friends, loved ones and peers," says Kendra, a volunteer distributor in Wilmington. "Without this amazing group of people and this life-saving drug, many people who are very close to me may not have had a second chance at life. In the last few months alone I have had close to 100 reversals reported to me personally and many of those people are now in recovery because they were ready to make a change in their lives after overdosing."

International

Mexican Popular Support for Marijuana Legalization Rising, But Still Low. This year's officially-supported debate on marijuana legalization appears to be having an impact. Mexico has never been a legalization-friendly country, and in October, daily polls had support for legalization at only 7%, with 92% opposed. But six months later, after the issue has been publicly debated, pro-legalization sentiment has increased four-fold, to 29%, with opposition dropping to 66%. The trend is in the right direction, but there's still a long way to go.

Chronicle AM: VT Gov Urges Lawmakers to Pass Legal Pot Bill, House Dems Urge Obama to Stand Tall at UNGASS, More... (3/18/16)

The taxman is happy in Oregon, Vermont's governor would be happy if the House passed the pot bill, New Orleans is a signature away from decriminalizing pot, Wisconsin's governor signs a package of bills to tamp down heroin and pain pill use, and more.

Some House Democrats are calling on President Obama to use the UNGASS on Drugs as a bully pulpit for global drug reform.
Marijuana Policy

Oregon Took in $3.48 Million in Marijuana Taxes in January. Even though legal marijuana is still for sale only through medical marijuana dispensaries, the state still sold an estimated $14 million worth of non-medical weed, resulting in the $3 million-plus funding gift to the state. State officials had predicted the take would be about $1 million.

Vermont Governor Urges House to Pass Legalization Bill. Gov. Peter Shumlin (D) told legislators "the time is now to take a smarter approach to marijuana" in a statement released Friday. "The stakes are important. The bill passed by the Vermont Senate would represent the most careful, deliberate attempt to regulate marijuana in America. Before passing the bill, the Senate took testimony from experts, asked the right questions, and learned lessons from those states that have legalized marijuana already. The result is a bill to create a system which would represent a huge improvement over the status quo….The choice in front of Vermonters and their elected representatives in the next couple of months is whether we want our state to take a rational step to end an antiquated War on Drugs policy that almost everyone agrees has failed. We can take a smarter approach in Vermont and be prepared for whatever other states around us do. But we must have the courage to do it." The House has taken up the legalization bill, Senate Bill 241, this week.  

New Orleans City Council Approves Decriminalization. The council voted unanimously Thursday night to approve an ordinance allowing police to write tickets instead of arresting people caught in possession of small amounts of marijuana. Fines will start at $40 and be capped at $100. The ordinance still needs to be signed by Mayor Mitch Landrieu.

Heroin and Prescription Opioids

Wisconsin Governor Signs Bill Package Targeting Heroin, Pain Pills. The package signed by Gov. Scott Walker (R) includes Assembly Bill 364, which requires doctors to check a database whenever they fill or refill a prescription for abusable drugs; Assembly Bill 365, which requires police to provide information to the Prescription Drug Monitoring database when they find evidence of prescription drugs being abused or stolen; Assembly Bill 366, which requires pain clinics to be certified by the state; Assembly Bill 367, which requires methadone clinics to provide relapse and other information to the state;  Assembly Bill 658, which makes it a crime to possess a use a masking agent to foil a drug test; and Assembly Bill 659, which streamlines rules for opioid treatment programs.

Drug Policy

House Democrats Urge Obama to Go Big at the UNGASS on Drugs. Fourteen House Democrats have urged President Obama to use the UNGASS as a bully pulpit for a call for substantive global drug reforms and moving away from failed criminalization strategies. Led by Reps. Earl Blumenauer (OR) and John Conyers (MI), the group urged the president to "take full advantage of this timely and powerful event to communicate our progress toward a more effective, science-based approach to drugs to the rest of the world." The Democrats called for Obama himself to deliver the US position before the General Assembly. "That unique platform gives you the opportunity to elevate the 2016 UNGASS on the World Drug Problem and change the way drug policy is approached, not only domestically, but also around the world, establishing the United States’ commitment to a new approach on an international scale," the letter reads.

International

Canada Petition Calling for Full Marijuana Legalization Gaining Steam. A petition asking the Canadian government to fully repeal marijuana prohibition is picking up signatures, especially in British Columbia. There are more than 12,000 signatures so far, more than 5,000 of them from BC. The petition launched by federal Green Party leader Elizabeth May calls for removing marijuana from the Controlled Drugs and Substances Act, ending police actions against existing storefronts, granting of pardons and expungements of criminal records to pot criminals, and leaving the regulation and taxation of marijuana commerce to the states. The Liberal government has said it is going to legalize it, but it hasn't said how or when. 

Chronicle AM: UK Lib Dems Call for Marijuana Legalization, MD Harm Reduction Bills Get Hearing, More... (3/8/16)

Massachusetts lawmakers have problems with pot legalization, a Utah medical marijuana bill gets gutted, a Florida medical marijuana bill goes to the governor, groundbreaking harm reduction bills get a hearing in Maryland, Britain's Liberal Democrats call for pot legalization, and more.

Britain's third political party calls for marijuana legalization.
Marijuana Policy

Poll: Illinois Not Quite There Yet on Marijuana Legalization. A new Paul Simon Public Policy Institute poll has support for legalization at 45%, with 51% opposed. Medical marijuana does much better, with 82% in favor.

Massachusetts Senate Committee Issues Report on Dangers of Marijuana Legalization. A day after legalization got a raucous hearing at the state house, the Special Senate Committee on Marijuana issued a report saying it had "serious concerns about the prospect of legalizing marijuana for recreational use and sale" in the state. Legalization could make it easier for children to get access to the plant and more difficult for law enforcement trying to enforce impaired driving laws. The report calls for setting a legal driving limit for THC levels in the blood, requiring health risk warnings on marijuana products, and barring home cultivation, among other recommendations.

Medical Marijuana

Florida Senate Passes Medical Marijuana Expansion Bill. The Senate Monday approved House Bill 307, which would allow terminally ill patients to use medical marijuana. The bill now goes to the desk of Gov. Rick Scott (R).

Utah House Committee Kills Broad Medical Marijuana Bill, Tries to Merge It With Another One. The House Health and Human Services Committee effectively killed Senate Bill 73, backed by medical marijuana supporters, then tried to blend in some of its provisions into Senate Bill 89, which would allow doctors to recommend medical marijuana products, but would also impose stricter regulations on its use. Sen. Mark Madsen (R-Saratoga Springs), sponsor of SB 73, said the compromise wasn't good enough. "It's like trying to put live organs in a cadaver and expect some kind of good outcome. It is fundamentally, functionally constructed to fail," Madsen said. "It's entirely possible they wanted it to fail all along. I don't think it's going to come close to meeting any of the needs for the people. It was a placebo bill from the beginning and was intended to torpedo my bill." Medical marijuana activists will now most likely move forward with a threatened initiative.

Virginia Lawmakers Approve CBD Cannabis Oil Bill. The House Monday passed Senate Bill 701, which would allow the cultivation and use of two cannabinoids—CBD and THC-A—for patients suffering from severe epilepsy. The measure has already passed the Senate and now heads the desk of Gov. Terry McAuliffe (D).

Harm Reduction

Maryland Hearing Today on Groundbreaking Harm Reduction Bill Package. The House of Delegates is today holding hearings on two bills from Del. Dan Morhaim (D-Baltimore County) that are part of paradigm-shifting, four-bill harm reduction package. House Bill 1212 would allow for supervised consumption rooms, while House Bill 1267 would take initial steps toward enacting a pilot project in heroin and other opioid maintenance therapy.

International

British Liberal Democrats Call for Marijuana Legalization. In a report issued today, A Framework for a Regulated Cannabis Market in the UK, Britain's third largest political party called for legalizing marijuana and said it would be a billion dollar a year industry in the United Kingdom.  

Chronicle AM: VT Senate Gives First Approval of Legalization Bill, CT MedMJ Expansion, More... (2/24/16)

Marijuana legalization advances in Vermont; medical marijuana advances in Connecticut, Australia, and Canada; Eric Holder says it's time to reschedule marijuana, Obama says restricting pain pills won't solve the opioid crisis, and more.

Busy, busy in New England. (wikimedia.org)
Marijuana Policy

Arkansas Attorney General Rejects Another Marijuana Legalization Initiative. Attorney General Leslie Rutledge (R) has again rejected a proposed constitutional amendment to legalize marijuana, citing ambiguities in the text. The Arkansas Cannabis Amendment, filed by Mary Berry, was rejected the first time earlier this month.

Vermont Senate Approves Legalization in Preliminary Vote. The Senate voted 16-13 to approve Senate Bill 241, which would regulate, tax, and legalize marijuana. The bill, which is supported by Gov. Peter Shumlin (D), faces one more Senate vote before heading to the House. That vote is expected to come tomorrow.

Minneapolis City Council Takes Up Decriminalization. The council will decide this week whether small-time marijuana possession should be a misdemeanor or a petty misdemeanor under city ordinance. The current ordinance makes it a misdemeanor punishable by a fine, jail time, and a criminal record. That's tougher than state law, which makes it a petty misdemeanor, which is punishable only by a fine and carries to criminal record.

Medical Marijuana

Former Attorney General Eric Holder Now Supports Rescheduling Marijuana. In an interview with PBS, Holder signaled newfound support for rescheduling and decriminalizing marijuana. It's not something he acted on while in office, but he now says: "I certainly think it ought to be rescheduled. You know, we treat marijuana in the same way we treat heroin now, and that clearly is not appropriate."

Connecticut Legislators Expand Qualifying Conditions for Medical Marijuana. The legislature's regulation review committee Tuesday approved expanding the state's program by adding six new qualifying conditions: ALS, or Lou Gehrig's disease; ulcerative colitis; sickle cell disease; severe psoriasis and psoriatic arthritis; complex regional pain syndrome; and post-laminectomy syndrome with chronic radiculopathy, which is recurring back pain after surgery. No other approval is required since these were regulatory, not legislative, changes. The changes will go into effect in 30 days.

Heroin and Opiates

Obama Says Restricting Opiate Prescriptions Won't Solve Crisis. At the National Governors' Conference last weekend, the governors recommended limiting the number of opioid pain relievers doctors can prescribe, but President Obama wasn't buying that. "If we go to doctors right now and say 'Don't overprescribe' without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we're not going to solve the problem, because the pain is real, the mental illness is real," Obama said in a meeting with governors Monday. "In some cases, addiction is already there."

Harm Reduction

Ithaca, New York, Unveils Comprehensive Drug Policy Plan. At a press conference today, Ithaca officials unveiled a comprehensive plan to deal with drug use from a public health perspective with a strong harm reduction component. The Ithaca Plan: A Public Health Approach to Drugs and Drug Policy, calls for the creation of a Vancouver-style Four Pillars (prevention, treatment, harm reduction, law enforcement) approach to the city's problems, particularly with heroin and opioid drug use. The plan recommends allowing supervised injection facilities and heroin maintenance, among other proposals.

International

Canadian Federal Judge Throws Out Ban on Patient Medical Marijuana Grows. A Vancouver-based federal judge ruled Wednesday that Health Canada regulations restricting patient medical marijuana grows violating charter rights and thus have no force and effect. But Judge Michael Phelan also gave the government six months to come up with new rules. In the meantime, an injunction allowing thousands of patients to grow their own remains in effect.

Australian Parliament Approves Medical Marijuana. Medical marijuana cleared the upper house Wednesday, clearing the way for its use Down Under. But several steps remain to be taken before a program gets up and running.

A Maryland Lawmaker's Paradigm-Shifting Approach to the Heroin and Pain Pill Crisis [FEATURE]

With nearly 47,000 Americans dying of drug overdoses in 2014 -- more than from gunshots or car crashes -- the problem of heroin and prescription opioid (pain pill) addiction is getting well-deserved attention. From community town halls to state capitals, as well as in Congress and on the rival presidential campaigns, the crisis is spawning demands for solutions.

http://stopthedrugwar.org/files/dan-morhaim-180px.jpg
Dan Morhaim
The response, in general, has been more sympathetic than to earlier waves of hard drug use, such as heroin in the 1960s or crack cocaine in the 1980s, which brought down the harsh drug war policies of Nixon and Reagan. Now, there are more calls for drug treatment than for further law enforcement crackdowns, police departments are carrying overdose reversal drugs, and public health agencies are taking on a more prominent role.

But addicts continue to be arrested, with all the deleterious consequences that entails, and, when it comes to policy, the problem of addiction remains largely in the realm of criminal justice. Harm reduction practices proven in other parts of the world improve both the lives of drug users and those of the communities they live in continue to be shunted aside in the US.

That could change in at least one state. Veteran Maryland Delegate Dan Morhaim (D-Baltimore County) has just introduced a paradigm-shifting package of bills that would begin to move the state's posture toward drug use from prohibition to public health and harm reduction. Morhaim, a practicing physician with three decades of frontline hospital ERs, brings to his approach a vision formed by that experience.

If enacted, Morhaim's package would mark a radical, but commonsensical, humane, and scientifically-supported shift in Maryland's drug policies. Here's what it includes:

  • Emergency Room Treatment on Demand. House Bill 908 provides treatment on demand in emergency rooms and hospital settings. The bill requires acute care hospitals to have a counselor available or on-call at all times and specified arrangements for transferring patients to appropriate treatment settings. Addicted patients make up a large percentage of uninsured visits to ERs, making them an ideal place for initial therapeutic contact.
  • Safe Consumption Sites. House Bill 1212 allows individuals to use drugs in approved facilities while supervised by trained staff who also provide sterile equipment, monitor the person for overdose and offer treatment referrals. Similar on-going programs in Australia, Canada, and several European countries have eliminated overdose deaths, reduced the spread of disease, and provided points of accessto the most hard-to-reach drug users.
  • Drug Decriminalization. House Bill 1219 decriminalizes the possession and use of small quantities of drugs: one gram of meth or heroin, two grams of cocaine, 10 hits of MDMA, 150 micrograms of LSD. The object is to keep otherwise non-criminal drug users out of the criminal justice system, saving resources and avoiding saddling more residents with criminal records.
  • Heroin Maintenance. House Bill 1267 allows a four-year pilot study of "poly-morphone assisted treatment" with pharmaceutical grade opioids, including heroin, to treat under medical supervision a small number of hardcore users who have proven resistant to other forms of treatment. Ongoing heroin maintenance programs in several European countries have been shown to reduce illegal drug use, decrease crime, reduce the black market for heroin, and lead to less chaotic lives for their participants.

The package didn't exactly come out of nowhere. Morhaim's experiences in the ER, where he dealt not only with direct consequences of drug use -- overdoses, infections -- but also direct consequences of drug prohibition -- old women injured in muggings for black market drug money, the toll of dead and wounded in black market drug turf battles -- colored his approach.

"I'm a physician, not a prosecuting attorney," Morhaim told the Chronicle. "I come at this from a public health perspective. We talk about 'surges' to fight this and that, but what we haven't had in this country is a surge in the public health approach, real, substantive public health. This is different, and some will see it as controversial, but I'm comfortable with that. This is something that's really corroding the heart and soul of our society."

He wasn't alone.

"I've had a lot of conversations, and my district has generally been very supportive of these kind of innovative things. No negative feedback. There's a broad consensus that the war on drugs is a failure," Morhaim said. "People are really cognizant of that. And I'm an Emergency Room physician at a Level II trauma center, I've also done healthcare for the homeless. I've been on the front lines, seen the carnage, the death, the violence, and the way this affects the families, and I'm speaking from true experience, and people respect that."

Not only did Morhaim have support in his community, he had support from a strong group of advocates and experts.

"As things were coming to a head, Delegate Morhaim reached out to us at the Drug Policy Alliance (DPA)," said DPA staff attorney Lindsay LaSalle, who was involved in developing the proposals. "He said he felt like he could offer progressive solutions to the crisis and he wanted our subject matter expertise to help develop those proposals."

DPA, Law Enforcement Against Prohibition (LEAP), whose executive director, Neill Franklin, is a former Baltimore police officer, and the Open Society Foundations joined with academics, lawyers, doctors, and harm reductionists to develop and refine the policy proposals that became the bill package. Local institutions of higher learning, including the University of Maryland, the University of Baltimore, and Johns Hopkins University, had academics involved in the effort as well.

Passing the bills won't be easy, and it's not likely to happen this year, but Morhaim and his supporters are playing to win in the not-too-distant future.

"Dan is currently on the second year of a four year term," LaSalle said. "These bills were introduced strategically this term with the understanding that it would be a year of educating colleagues and generating positive media coverage. This is always a long game; we don't expect passage this year, but we hope to gain traction on one or more of these in the next two or three years."

"I've been in the legislature a long time, and I've learned you just have to be persistent, you listen and address concerns, maybe you accept an amendment to a bill," Morhaim said.

He pointed to the successful effort to get medical marijuana through the legislature.

"On that, people had suggestions, and we said let's fix it in the bill," he recalled. "Law enforcement didn't oppose it because I sat down and worked with them."

He also recalled legislative battles he had fought -- and won -- around smoking in restaurants and the use of safety seats for children.

"Banning smoking in restaurants seemed impossible in 1995, but now it's commonplace," he said. "The same with kids safety seats. Both of those were hard-fought on the political level, but when we talk to people, we can convince them. These things take time, but when you recognize what's not working, then you can explore what is. People are looking for answers."

Although Morhaim's package of bills is the most comprehensive, explicit harm reduction interventions are being considered in other places, too. California will see a safe consumption site bill introduced next week, and activists and officials in a number of cities, including New York City, San Francisco, and Seattle are laying the groundwork for such facilities at the local level.

"We're getting traction on these issues," said LaSalle. "Nevada was the first state with a heroin-assisted treatment bill, and while it didn't get out of committee, we had robust hearings, with international experts. And that California bill will be moving forward this session. Drug treatment and harm reduction don't always go hand in hand, but in this case the treatment community is cosponsoring or officially supporting safe consumption sites."

Meanwhile, some states are moving in the opposite direction. In Maine, the administration of Tea Party Gov. Paul Le Page (R) is seeking to reverse a law passed last year that defelonized drug possession. (The rambunctious Republican has also called for guillotining drug dealers, blamed black drug dealers for impregnating white Maine girls, and called for vigilantes to shoot drug dealers.) And next door in New Hampshire, the attorney general wants to start charging heroin suppliers with murder in the event of fatal overdoses. Prosecutors in other states have also dusted off long-unused statutes to bring murder or manslaughter charges.

"We need to ask those people why they're doubling down on a failed policy," said LaSalle. "Why would this work now when it's just more of the same that's been in place for four decades, and now we have use and overdoses and Hep C increasing."

"I understand the impulse to 'Do Something!' in response, and because criminalization has been our go-to response, it seems logical that increasing penalties or prosecutions is a way to solve the problem, but we know, we have shown, that it is not. It's frustrating."

It can be worse than frustrating, too, LaSalle noted.

"Using murder charges as a whipping stick in the case of overdoses is really counterproductive," she said. "If the goal is to reduce overdoses, this is going to reduce the likelihood of anyone calling 911. Maybe they shared their stash, and if they could face murder charges, they now have a serious disincentive to call."

Clearly, the war on drugs is not over. But after half a century of relying predominantly on the forces of repression to deal with drug use, a new vision, both smarter and more humane, is emerging. Now comes the political fight to enact it.

Annapolis, MD
United States

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